OpenUCT :: Browsing by Subject "Health Innovation"

Browsing by Subject "Health Innovation"

Now showing 1 - 8 of 8

Open Access
Analysis of orthopaedic device development in South Africa: Mapping the landscape and understanding the drivers of knowledge development and knowledge diffusion through networks
(2021) Salie, Faatiema; Douglas, Tania; de Jager, Kylie
An orthopaedic medical device refers to a part, implant, prosthetic or orthotic which is used to address damage to the body's musculoskeletal system, primarily by providing stability and mobility. Orthopaedic medical devices play a role in injury-related disorders, which have been highlighted as a key element of the quadruple burden of disease in South Africa. In this thesis, orthopaedic devices are conceptualised as a technological field and a technological innovation system (TIS) framework is applied to understand orthopaedic device development in South Africa. Knowledge development and knowledge diffusion are fundamental components of any innovation system. The thesis hypothesises that the functions “knowledge development” and “knowledge diffusion through networks” of the orthopaedic devices TIS are influenced by contextual factors. The objectives of the study are: to identify the actors who generate knowledge for orthopaedic device development and to characterise the relationships between them; to identify focus areas of orthopaedic device development; to provide insight into the drivers and barriers to knowledge development and diffusion in the TIS; and to identify the contextual factors that influence knowledge dynamics in the TIS. These objectives are investigated using social network analysis based on bibliometric data (scientific publications and patents), keyword networks, a review of institutions, and a set of case studies where the primary data source are interviews with actors. Actors producing knowledge were from the university, healthcare, industry and science council sectors, although science councils played a small role. International actors were shown to bring new ideas into the TIS. The networks were fragmented, illustrating that knowledge diffusion through the networks was limited. This was especially the case in the patent networks as many actors patent in isolation. The keyword networks highlighted unrealised collaboration potential between actors based on their common research interests. The case studies revealed features of cross-sector interaction for orthopaedic device development not evident from network analysis based on bibliometric data. Drivers of knowledge development and knowledge diffusion were: inter-sectoral collaboration; the availability of resources; the affordability of available devices; and the positive externalities of allied TISs. The main barrier to knowledge development and diffusion was in the form of barriers to intersectoral collaboration. These include unmatched expectations from partners in collaboration, different views on intellectual property ownership, and burdensome university administrative processes. The orthopaedic devices TIS was structurally coupled to the embedded TIS and sectoral contexts, and externally linked and structurally coupled to its political context. Knowledge development and diffusion was found to be positively enhanced by innovation in the additive manufacturing TIS, with shared structural elements and resources. Knowledge development and diffusion was influenced by sectoral dynamics of the university, healthcare and industry sectors. This thesis makes the following contributions. First, it applies the TIS framework to a new focus area, namely medical device development, in a developing country context. Second, it makes two unique methodological contributions: it presents an index to capture the extent of sectoral collaboration in a network; and it develops a method for determining the collaboration potential of actors in a network based on cognitive distance.
Open Access
Automated analysis of digital medical images in cervical cancer screening: A systematic review
(2023) Ledwaba, Leshego; Mutsvangwa, Tinashe
Background Cervical cancer is the second highest cause of mortalities in women living in resource-constrained countries compared to those living in high income countries, due to lack of organized population screening. Cervical cancer screening is the best way to detect lesions and remove them before they advance into malignancy. In South Africa, the current standard cervical cancer screening protocol begins with cytology examination then a referral for colposcopy follows if the cytology screening test is abnormal. Thereafter, histopathology examination is conducted on biopsy specimen collected during colposcopy. Biopsy specimen are only collected when suspicious lesions are observed during colposcopy. These screening procedures need to be performed by qualified specialist clinicians because accuracy of diagnosis is highly dependent on the skill level and experience of the clinician making the diagnostic decision. In South Africa, colposcopy and cytology are constrained by a shortage of specialists and expensive diagnostic infrastructure. Consequently, public health interventions such as population screening programs for cervical cancer are poorly implemented. Researchers have been developing low-cost portable devices, some of which are incorporated with automated image analysis to enhance diagnostic decision-making. The methods for incorporating automation within each domain of the cervical cancer screening protocol are becoming numerous as researchers continue to advance the field. As the knowledge base is growing rapidly, progress on the implementation status of novel imaging devices and novel algorithms in cervical cancer screening has become unclear. Thus, there is a need to identify all relevant technologies, i.e. devices and algorithms, currently being researched in the field, and to understand their unique strengths and challenges toward clinical adoption. The aim of this project was to provide a systematic review summarizing the full range of automated technology systems used in cervical cancer screening. Method A systematic search on five main academic databases (PubMed, Scopus, EBSCOhost, Web of Science and Google Scholar) was conducted to identify articles on automated technology systems applied in cervical cancer screening. The search results were screened by two independent reviewers to assess eligibility in meeting Population, Intervention, Comparator, and Outcome (PICO) criteria. The screening of articles was a two-step approach: firstly, screening for eligibility by only reading the title and abstract of articles; then secondly, screening by reading full texts. A data extraction form was developed and used to systematically summarize information contained in 70 studies that were included for analysis. Bias in each study was assessed using a risk of bias template adapted from established checklists, namely the Cincinnati Children's LEGEND guideline and the Joanna Briggs Institute critical appraisal checklist for diagnostic test accuracy studies. A conceptual map of common computer aided diagnostics (CAD) tasks that make up the automation pipeline was developed as a narrative tool to synthesize the specific functions that proposed CAD algorithms in multiple screening domains were performing. Results This systematic review found 16 studies which reported application of algorithms paired with novel image acquisition devices, and 52 studies reporting on standalone image analysis algorithms. CAD algorithms associated with acquisition devices (both novel and conventional) revealed that automated analysis achieved superior performance than manual expert analysis; thus, improving diagnostic decisions made by clinicians performing colposcopy, cytology and histopathology. The pertinent algorithms were those developed for devices designed with a mobile phone or tablet, which were the Pocket Colposcope, MobileODT EVA Colpo, Smartphone Camera, Smartphone-based Endoscope System, Smartscope, Mobile high resolution micro-endoscopy (mHRME), and Pi high resolution micro-endoscopy (PiHRME). These mobile-based systems in particular could be applied more widely in low- to middle-income countries than bulky devices because of their anticipated low purchase cost. Most interventions were in the feasibility stage of development, undergoing initial clinical validations. Conclusion This review found that cervical cancer screening researchers have proven the positive clinical impact that CAD algorithms might have in reaching outstanding prediction performance. This accomplishment is a significant step toward minimizing reliance on experts to provide cervical cancer screening services. Furthermore, the systematic review summarized evidence of the algorithms which are being created utilizing portable devices, to circumvent constraints prohibiting wider implementation in LMICs (such as expensive diagnostic infrastructure). These advances can make the decentralization of colposcopy services more feasible if unsupervised community health workers are trained to effectively utilize portable imaging devices with automated functionality for interpreting results. However clinical validation of promising novel systems is not yet implemented adequately in LMICs, because most studies did not include nurses who are a crucial segment of the target population. Additionally, it is not clear whether the proposed portable interventions are economically feasible when hidden costs are also taken into account.
Restricted
Development of an assessment framework for student engagement in design thinking projects for health innovation
(2020) Dikgomo, Kagiso; Douglas, Tania S; Mutsvangwa, Tinashe; Hendricks, Sharief
Student engagement is a dynamic and multifaceted concept – it encompasses physical, emotional, and cognitive components. Various instruments to assess student engagement exist, however these are not intended to assess how students engage with one another and with community stakeholders in participatory health projects. Although instruments do exist to assess participation/power-sharing in participatory health projects, none of the available instruments are suitable for the assessment of student engagement in such projects. The current study set out to develop an assessment framework for student engagement in design thinking projects for health innovation. Design thinking is a human-centred and participatory approach to problem-solving. The objectives of the project were: (1) the design and implementation of a questionnaire to assess student engagement in design thinking activities, and (2) assessment of the validity of the questionnaire. A preliminary questionnaire was developed with the aid of the literature and implemented for students taking a postgraduate course called Health Innovation & Design, which follows a design thinking approach for health innovation. Analysis of students’ written reflective reports and a focus group discussion were used to revise the questionnaire items. The revised questionnaire was validated by design thinking practitioners (the course lecturer and facilitators), and further modifications were made based on their views. The assessment framework developed in this study incorporates the design thinking phases according to the IDEO design thinking approach, an educational definition of student engagement, and recommendations by students of the Health Innovation & Design course and their course lecturer and facilitators. This questionnaire may be used to assess engagement in academic settings as well as non-academic settings when design thinking is applied for health innovation.
Open Access
Evaluating the usability of an X-ray imaging system in forensic pathology
(2018) Mutswangwa, Christopher T; Douglas, Tania S
Post mortem imaging (PMI) is increasingly being adopted as an alternative to invasive autopsies in forensic pathology. PMI can be used as a sole technique or adjunct to an autopsy. The Lodox Xmplar-dr is an X-ray imaging system that has been adopted for use in PMI. The purpose of this study was to evaluate the perceived usability of this imaging system by focusing on the satisfaction of forensic pathologists in use of the system. Assessment of satisfaction was guided by the subjective satisfaction characteristics of likability, pleasure, comfort and trust. Incorporation of user needs into updated system designs may lead to greater perceived ease of use, acceptance and adoption, resulting in increased device utilisation. The study location was the Lodox Xmplar-dr installation site at the Salt River Forensic Laboratory, Cape Town. Five forensic pathologists were observed using the Xmplar-dr system and four were interviewed on their experience using the system. A qualitative research design which used thematic analysis with the aid of NVIVO11 qualitative data analysis software was used to extract key usability and satisfaction themes emerging from the data, to show the extent of user satisfaction. Two key themes emerged. These were categorised as forensic pathologist-related, which focused on the hedonistic and subjective aspects of their satisfaction with the system, and systemrelated, which centred on the satisfaction users derived from the system’s ability to meet their pragmatic and objective expectations in their use of the system. In general, the forensic pathologists were satisfied with the Xmplar-dr system and it exceeded their expectations. Pleasure was derived from the ability of the system to increase work throughput by reducing the need to perform a dissectional post-mortem unless it was deemed absolutely necessary, i.e. when cause of death could not be determined from the X-ray images generated by the system. Participants felt that the system was an indispensable device when performing post mortems. Likability came from the ease of learning to use the basic functions of the system; the study participants stated that the system aided them in determining cause of death and saved time, in line with the definition of the likability characteristic that is centred on the extent to which a user is satisfied with perceived achievements of pragmatic goals. Trust was derived from participants’ views that the system worked as intended, although there could be improvements in terms of robustness, reliability and the imaging system`s support services. Image manipulation on the human-computer interface (HCI) and image representation were concerns highlighted. Most functions could be performed through the system’s HCI rather than by manipulation of the body being examined; this increased the physical comfort satisfaction characteristic. The need for manual placement of bodies on the system`s table by assistants and the associated health consequences were however raised as a concern that diminished the comfort-in-use characteristic of satisfaction. Understanding the user experience of the forensic pathologists who use the Lodox Xmplar-dr system to perform post mortems enabled the identification of areas for improvement. The improvements may increase user satisfaction resulting in better utilisation of the imaging system. The insights gained may be useful for the design of other imaging systems used in forensic pathology.
Open Access
Impact of the Functional Resonance Analysis Method (FRAM) in safety management at healthcare organisations
(2021) Wessels, Maatje; Fortuin, Jill; Douglas, Tania
Patient safety events are likely to be one of the ten leading causes of death and disability in the world (World Health Organization, 2020). To manage safety, healthcare organisations have traditionally focused on identifying failures, performing analysis of events, and developing strategies to reduce the failures. Several thought leaders have argued that the traditional method is not adequate to manage safety in a complex environment. Their argument is that safety management should not solely focus on what went wrong, it should also include efforts which enable things to go right more often. If healthcare organisations want to broaden their approach towards managing safety, suitable methods must be investigated. The Functional Resonance Analysis Method (FRAM) was developed by Hollnagel in 2004 and has been applied in high-risk industries such as railway, aviation, maritime and healthcare. FRAM investigates the interaction of the different functions within a complex, underspecified system, and improves the understanding of normal work and its variability (Hollnagel, 2012). This systematic review will assess the application of FRAM in healthcare settings to develop a rich understanding of the application of FRAM in healthcare as a complementary method to safety management. Firstly, understanding how FRAM was implemented within healthcare organisations and secondly understanding how healthcare organisations have perceived the value-add of FRAM in terms of safety management. The results are expected to provide healthcare organisations with guidance on applying the FRAM and demonstrate the value it potentially adds to safety management. In the studies reviewed, FRAM was applied in a wide variety of settings and in different contexts. Thematic value-added aspects were identified and discussed. Shortcomings and prerequisites for the application of FRAM was also highlighted. This dissertation wishes to motivate healthcare organisations to investigate and apply alternative methods such as FRAM to enhance their ability to manage safety in a complex environment.
Open Access
Network analysis of Diagnostic Medical Device Development for Infectious Diseases Prevalent in South Africa
(2018) Nyathi, Nonku; Douglas, Tania; De Jager, Kylie
Infectious diseases are a major health concern in South Africa and many other developing countries. The local development of medical devices for infectious diseases in such settings, utilizing the local knowledge base, has the potential to improve the accuracy of and access to diagnoses and to lead to the devices being more context-appropriate and affordable. The aim of this project was to examine the landscape of diagnostic medical device development targeting infectious diseases prevalent in South Africa for the period 2000-2016, particularly with regard to collaboration between institutions in different sectors and the contributions of different collaborators. Such knowledge would be beneficial to future technological and policy developments aimed at improving access to diagnostic services and treatment in the South African context. Collaboration across four sectors was considered: university, hospital, industry and science councils and facilities. A bibliometric analysis was performed, and publications documenting medical device development for diagnosis of infectious diseases were extracted. Co-authorship of the journal and conference articles was used as a proxy for collaboration across organisations. Affiliation data extracted from the publications were used to generate a collaboration network. Netdraw, a network visualisation tool, was used to visualize the network, and network metrics such as degree centrality, betweenness centrality and closeness centrality, as well as group density measures, were produced using UCINET software. The collaboration network and the network metrics were used to determine which organisations have collaborated and which collaborators have played the most active and influential roles in diagnostic device development. The university sector was found to make the largest contribution to the development of diagnostic medical devices in South Africa, and also played a key role in transmitting information throughout the network due to its high frequency of connections to other organisations. The most prevalent type of inter-sectoral collaboration was between universities and science councils and facilities, while universities were found to collaborate most amongst themselves with regard to intrasectoral collaboration. Foreign organisations played a prominent role in diagnostic device development between 2012 and 2016. Tuberculosis was the most prevalent infectious disease in diagnostic device development research, and computer-aided detection was a common feature of research on diagnostic device development.
Open Access
The Effect and Potential of Digital Health in The Cycle of Care in Tuberculosis Patients from Low and Middle-income Countries
(2021) le Roux, Jacobus Johannes; Fortuin, Jill
Background LMICs account for approximately 87% of all new TB cases. Effective TB management is vital if the global end TB goals are to be achieved by 2035. The role of digital health (DH) interventions in achieving these goals are pertinent. TB treatment adherence is considered to be critical not only in successful eradication of the disease, but also in the containment of drug-resistant strains of the disease. This review set out to assess the effect of DH interventions on TB patient treatment adherence in LMICs. Methods A systematic review was conducted by searching various databases (Pubmed, Scopus, EBSCOhost Web of Science) as well as grey literature sources for literature incorporating randomized controlled trials (RCTs), cohort, or cross-sectional studies which assessed DH interventions aimed at improving TB patient treatment adherence within LMICs. Studies were included if they were reported primary outcomes related to patient treatment adherence and were published in English before 30 November 2020. The risk of bias was independently assessed using the Cochrane Risk of Bias Assessment Tool. Results Out of the 1030 articles identified through the databases, 41 articles were full text screened and eleven included in the synthesis of this review. Seven studies utilized text-based reminders, two employed electronic medication monitors, and two employed call reminders, and one involved video observed therapy (VOT). Grouped analysis of all included studies yielded a marginal improvement in positive patient treatment outcomes (RR 1.05, 95% CI 1.02 - 1.09). Conclusion DH interventions show promise in improving patient adherence and positive treatment outcomes. Current available literature remains scarce and of questionable quality. Studies incorporating a patient-centred approach which is executed according to standardized implementation procedures and outcome assessment is required.
Open Access
User-interface design and evaluation in a mobile application for detecting latent tuberculosis
(2019) Farao, Jaydon Ethan; Douglas, Tania Samantha; Malila, Bessie; Mutsvangwa,Tinashe
Treatment and monitoring of tuberculosis have been met with various interventions to reduce its prevalence. One such intervention, to detect and prevent latent tuberculosis infection (LTBI), is the tuberculin skin test (TST), for which an induration response on a patient’s arm is an indication of LTBI. The test requires the patient to return to a clinic 48 to 72 hours after TST administration for assessment of the response. This is a challenge because of financial and accessibility obstacles, especially in under-resourced regions. A mobile health (mHealth) application (app) has been developed for remote assessment of the response to the TST. The previous version of the LTBI screening app, however, had usability limitations. The app is intended for use by patients and healthcare workers; thus, ease of use is important. There is a lack of literature on the usability of mHealth apps, especially in under-resourced settings. In this project, the user interface of the app was redesigned and tested. The Information Systems Research (ISR) framework was integrated with design thinking for this purpose. The project included creating mock-ups of the interface which were iteratively prototyped with ten student participants, adjusted, and assessed according to the user feedback. Thereafter, the Android Studio software was used to adjust the user interface based on the insights gained through the progression of prototypes. The usability of the updated app was tested and assessed with ten healthcare workers at a community health clinic in Khayelitsha in Cape Town, South Africa. Data collection and analysis comprised both qualitative and quantitative methods. Observations, the “think aloud” approach, and the post-study system usability questionnaire were used for data collection. Student participants highlighted various usability limitations of the app during each iteration. The major usability limitations included: the complex image capture protocol, misunderstanding of instructions, and time taken to capture images. Engagement with students allowed for improvement of the app interface and enabled adequate preparation for testing in the field with end-users. Furthermore, improving the app interface before engaging with healthcare workers, enabled context specific limitations that would affect the usability of the app, to be explored during the field testing. These included safety concerns when using the app and the privacy of health information. Future work should explore how these concerns, as well as other social factors, affect usability. Furthermore, improving the image capture protocol is required for improving the usability of the app.

Browsing by Subject "Health Innovation"

Results Per Page

Sort Options